Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial

Abstract

Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.

The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

“…35,36 Cointerventions did not differ between treatment groups in 4 of the trials. [29][30][31][32]38 The follow-up rate was greater than 70% in all admissible studies, and most studies (8/10) had a follow-up rate greater than 80%. [29][30][31][32][33][34][35][36][37]39 Nevertheless, the studies with low risk of bias had limitations.…”

“…Of those, 15 studies (published in 19 articles) were eligible for critical appraisal. [29][30][31][32][33][34][35][36][37][38][39][40][52][53][54][55][56][57][58] Ten studies (published in 12 articles) had low risk of bias and were included in the best evidence synthesis. [29][30][31][32][33][34][35][36][37][38][39][40] The interrater agreement for the screening of titles and abstracts was κ = 0.91 (95% CI, 0.82-1.00).…”

“…[29][30][31][32][33][34][35][36][37][38][39][40] Three RCTs investigated participants with persistent subacromial impingement syndrome, 29,31,32,35,36 and 2 addressed subacromial impingement syndrome of variable duration. 38,39 Two RCTs studied persistent nonspecific shoulder pain, 30,33 2 targeted participants with variable duration nonspecific shoulder pain, 34,37 and 1 addressed rotator cuff tendinitis of variable duration. 40 Twelve different multimodal programs of care were tested in the 10 RCTs (Table 3).…”

“…Most multimodal programs of care (11/12 programs) included exercise. [29][30][31][32][33][34][35][36][37][38][39][40] The studies were clinically heterogeneous, and their results could not be pooled in a meta-analysis.…”

“…[29][30][31][32][33][34][35][36][37][38][39][40] Nine studies had adequate allocation concealment (9/10). [29][30][31][32][33][35][36][37][38][39][40] Seven studies had similar baseline characteristics between treatment arms. [29][30][31][32][33][34]37,40 Only 1 RCT with baseline differences between treatment arms controlled for these differences in their analysis.…”